When performing a draw on a diabetic patient with small, fragile veins, and the phlebotomist misses the patient's vein twice, what should the phlebotomist do next?
Ask another phlebotomist to obtain the specimen.
Perform the draw on a foot.
Repeat the draws until the phlebotomist is successful.
Perform the draw on a leg.
The Correct Answer is A
Choice A reason:
Asking another phlebotomist to obtain the specimen is a prudent step after multiple unsuccessful attempts. It can reduce the patient's discomfort and anxiety. A fresh perspective from another professional might increase the chances of a successful draw, especially in challenging situations like small, fragile veins often found in diabetic patients.
Choice B reason:
Performing the draw on a foot is not typically recommended due to the increased risk of infection and complications, especially in diabetic patients who may have reduced sensation and slower healing in their extremities. This option should only be considered when other more proximal sites have been deemed unsuitable.
Choice C reason:
Repeating the draws until successful is not advisable as it can cause undue stress to the patient and increase the risk of hematoma or vein damage. It is essential to minimize the number of attempts to prevent patient discomfort and potential complications.
Choice D reason:
Performing the draw on a leg is another option that is generally avoided unless absolutely necessary, due to similar reasons as drawing from a foot—risk of infection and complications. Additionally, it can be an uncomfortable position for the patient.
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Correct Answer is B
Explanation
Choice A Reason:
An angle of 50° is too steep for venipuncture and increases the risk of going through the vein and causing injury to structures beneath it. A steeper angle can also make it more difficult to control the depth of the needle, leading to an increased chance of puncturing the posterior wall of the vein.
Choice B Reason:
An angle of 30° is the recommended angle for venipuncture as it allows for a smooth entry into the vein without going too deep. This angle helps to ensure that the needle enters the vein in a controlled manner and minimizes the risk of injury to the patient. It also provides a good balance between ease of entry and control over the needle's depth.
Choice C Reason:
An angle of 90° is not recommended for venipuncture because it is perpendicular to the skin, which greatly increases the risk of passing through the vein entirely and causing injury. This angle does not allow for any control over the depth of the needle and is likely to cause discomfort or pain to the patient.
Choice D Reason:
An angle of 75° is also too steep for safe venipuncture. Similar to a 50° angle, it increases the risk of penetrating the posterior wall of the vein and potentially damaging surrounding tissues or arteries. It is important to use a lower angle to ensure the safety and comfort of the patient during the procedure.
Correct Answer is C
Explanation
Choice A Reason:
Warfarin does not typically require a fasting state before blood is drawn for testing. The medication's effect on clotting factors is independent of food intake. Therefore, a fasting requirement is not anticipated for patients taking warfarin unless specified for other concurrent tests.
Choice B Reason:
There is no need for an alternate antiseptic due to warfarin use. Standard antiseptic procedures are sufficient when drawing blood from patients on warfarin. The choice of antiseptic would be more influenced by patient allergies or specific institutional protocols.
Choice C Reason:
Patients on warfarin have an increased bleeding time because the medication is an anticoagulant, which means it works to prevent blood clots by thinning the blood. This can lead to prolonged bleeding after a venipuncture, and phlebotomists should be prepared to apply pressure for a longer time to ensure hemostasis.
Choice D Reason:
Placing a specimen on ice is not a standard procedure for blood samples taken for warfarin monitoring, which is typically done through a PT/INR test. This test measures the time it takes for blood to clot and is not affected by temperature in the same way that tests for certain enzymes or gases might be.
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